As is well known, cataract surgery is an ophthalmologic surgical procedure for removing an opaque intraocular lens from an eye. In accordance with this surgical procedure, after the intraocular lens is removed, an artificial intraocular lens needs to be implanted to recover the patient's vision. It is desirable for an ophthalmologic surgical microscope that is used during the surgical procedure to have a capability of auto-focusing on the intraocular lens capsule during the surgical procedure, which capability is especially important after a majority of the opaque intraocular lens has been removed. After a majority of the opaque intraocular lens has been removed, small amounts of cataract residue may remain on the optically transparent intraocular lens capsule--because the intraocular lens capsule is transparent, such residue is difficult to see. As is known, it is important to completely remove such residue because any residue left on the intraocular lens capsule will serve as a nucleus of a new cataract. Present apparatus for auto-focusing an ophthalmologic surgical microscope, such as a prior art apparatus disclosed in U.S. Pat. No. 5,288,987 issued Feb. 22, 1994, are based on detecting and measuring the intensity of light scattered from an object. However, such apparatus for auto-focusing are disadvantageous because it is difficult to focus on an optically transparent medium such as the posterior intraocular lens capsule since reflection therefrom is specular and weak.
In light of the above, there is a need in the art for an ophthalmologic surgical microscope which can auto-focus on the posterior intraocular lens capsule for use in cataract surgery.
As is well known, refractive surgery is a surgical procedure that has, as its primary objective, correction of an ametropia by making incisions in a cornea to change the refractive power of the cornea. Surgical manipulation of corneal shape requires an accurate and precise method of measuring anterior corneal curvature from apex to limbus. At present, measurement of curvature of the center of the cornea is commonly made using a keratometer and, for more precise measurements of corneal topography, it is common to utilize photokeratoscopy or videokeratoscopy.
Current corneal topography measurement apparatus are mostly Placido-disc-based videokeratoscopes. In such an apparatus, a series of concentric rings are configured on a cone-shaped housing so that an image reflected from the cornea is virtually flat in space. Then, the configuration of the rings is analyzed to determine the corneal topography. A prior art apparatus of this type has been described in an article entitled "New Equipment and Methods for Determining The Contour of the Human Cornea" by M. G. Townsley, Contacto, 11(4), 1967, pp. 72-81. Such videokeratoscopes have the following disadvantages: (a) due to the small radius of the cornea (.about.8 mm), a limited number of rings can be resolved on the cornea (normally, the contour which can be measured is restricted to an area which ranges from 0.8 to 11 mm in diameter on the cornea); (b) no information can be obtained between the rings; and (c) due to use of rings, in-line measurement is very difficult when used in conjunction with an ophthalmologic surgical microscope. An article entitled "Accuracy and Precision of Keratometry, Photokeratoscopy, and Corneal Modeling on Calibrated Steel; Balls" by S. B. Hannush, S. L. Crawford, G. 0. Waring III, M. C. Gemmill, M. J. Lynn, and A. Nizam in Arch. Ophthalmol., Vol. 107, August 1989, pp. 1235-1239 provides a comparison of these prior art methods and apparatus.
Another corneal topography measurement apparatus has been developed recently by PAR Microsystem Co. The apparatus utilizes raster photogrammetry to measure a corneal topography. In this apparatus, a grid pattern is projected onto the cornea. The grid pattern is then viewed and imaged from an offset angle. Finally, corneal elevation at each of the discrete points in the grid pattern are calculated using the image of the projected grid pattern, and information relating to its geometry. This apparatus is described in an article entitled "Intraoperative raster photogrammetry--the PAR Corneal Topography System" by M. W. Berlin, J. Cataract Refract Surg, Vol. 19, Supplement, 1993, pp. 188-192. Corneal topography measurements suffer in this apparatus because only a limited number of points in the image of the projected grid pattern can be resolved by the image optics.
As is further known, since a posterior corneal surface contributes about -14% of total corneal refractive power, in some cases, an anterior corneal topography, by itself, does not provide sufficient information for use in a refractive surgical procedure. For that reason, it becomes even more important to obtain corneal topography measurements with a precision that cannot be provided by current corneal topography measurement apparatus.
In light of the above, there is a need in the art for an ophthalmologic surgical microscope which can perform in-line, corneal topography measurements for use in refractive surgical procedures.
Recently, a new ophthalmic measurement apparatus, an optical coherence tomography ("OCT") apparatus, has been disclosed which has advantages over the above-described prior art ophthalmic measurement apparatus. An OCT apparatus uses a short coherence light source for range measurements based on the principle of white light interferometry. OCT has been proposed recently for use in several ophthalmologic applications. For example, such proposals have been made in a preprint of an article which has been submitted for publication entitled "Micron-Resolution Imaging of the Anterior Eye in Vivo with Optical Coherence Tomography" by J. A. Izatt, M. R. Hee, E. A. Swanson, C. P. Lin, D. Huang, J. S. Schuman, C. A. Puliafito, and J. G. Fujimoto, 1994, pp. 1-24. The preprint discloses an OCT apparatus which utilizes optical fiber technology and a superluminescent laser diode source, which OCT apparatus is interfaced with a slitlamp biomicroscope for imaging intraocular structures with a spatial resolution of 10-20 .mu.m. The preprint discloses the use of the OCT apparatus to provide direct, micron-resolution measurements of (a) ocular profile dimensions, optical scattering, and structure in the cornea; (b) the anterior angle region; (c) the iris; and (d) the crystalline lens. The preprint further discloses the use of the OCT apparatus to measure: (a) anterior chamber depth, defined as a distance, along the visual axis, from the posterior corneal surface to the lens anterior capsule; (b) radius of curvature of the posterior and anterior surfaces of the cornea; (c) corneal refractive power; and (d) corneal dimensions such as thickness. The preprint still further discloses that the OCT apparatus, using an inexpensive diode laser source and a fiber optic implementation, is compatible with existing ophthalmic instrumentation. Finally, the preprint makes the following suggestions for potential clinical applications of OCT: (a) providing cross-sectional images of the entire anterior chamber for use in elucidating pathologies of the cornea, anterior angle region, and iris and for use in identifying and monitoring intraocular masses or tumors; (b) measuring anterior chamber depth, corneal curvature, and corneal refractive power; and (c) providing high resolution images showing corneal thickness variations and the distribution of scattering in corneal stroma for quantitative analysis of corneal pathologies.
As is well known, lasers are used in eye surgery for various applications, of which, perhaps the most important are photocoagulation of the retina and photoablation of the cornea. In such applications, laser radiation interacts with ocular tissue and causes structural and topological changes of the tissue. Such applications typically entail monitoring such tissue changes visually on a video monitor by means of a CCD microchip interface or through a binocular eye piece with an ophthalmologic surgery biomicroscope. However, the CCD image of the prior art is limited for two basic reasons. The first reason the CCD image of the prior art is limited is that the CCD image only provides an image of tissue surface. For laser treatment of macular holes, for example, although there is a need to limit tissue coagulation to a well defined area to avoid unnecessary damage of visual functions, there is also a need to limit tissue coagulation in depth to avoid bleeding of the highly perfused coroidal layer. Another example of the need to limit tissue changes in depth is the need to avoid damage of the endothelium layer of the cornea during laser ablation for photorefractive surgery. The second reason the CCD image of the prior art is limited is that it does not provide a quantitative method for controlling tissue change based on laser power, exposure, and spot size.
In light of the above, there is a need for an apparatus for use in laser treatment for controlling the extent of tissue change during the laser treatment and for controlling the tissue change based on laser power, exposure, and spot size.